DOCKET NUMBER WAIVER OF COUNSEL Trial C ourt of M ass ach use tts District Court Department C O U R T D IV IS IO N COM M ONW EALT H VS ________________________________________________________ _ _ _ _ _ _ __ _ _ _ _ _ _ _ N AM E O F D E F E N D A N T Nombre del Acusado WAIVER OF COUNSEL R E N U N C IA A L D E RE C H O A SE R R EP R E SE N T A D O P O R U N A BO G A D O I, the above named defendant, have been informed of my right to have a lawyer represent me at every stage of the proceedings in this case, and that if I cannot afford to hire my own lawyer, this Court will assign the Co mmittee for P ub lic Counsel Services to provide representation for me. KNOWING THAT I HAVE A RIGHT TO HAVE A LAWYER REPRESENT ME, I NE VE RT HE LE SS ELEC T T O P RO CE ED IN THIS MATTER WITHOUT A LAWYER AND WAIVE MY RIGHT TO SUCH A LAWYER. Yo, el Acusado nombrado anteriormente, he sido informado del derecho a tener un abogado que me represente en cada una de las etapas del proceso de este caso y se m e ha informad o que de n o contar con los recursos para contratar a m i prop io aboga do, el Tribuna l le asign aría mi representación al Comité de Servicios Legales Públicos. SIN EMBARGO Y CON PLENO CON OCIMIENTO DEL DERECHO A QUE ME REPRESENTE UN AB OG AD O, D ECID O SE GU IR AD ELA NT E CO N E STE ASU NT O SIN ABOGADO Y RENUNCIO AL DERECHO DE SER REPRESENTADO POR EL MISMO. ___________________________ ________________________________________________________________________ DATE S I G N A TU R E O F D E F E N D AN T Fecha Firma del Acusado _ _ _ _ _ _ _ _ _ _ _ _ _ __________________ DATE Fecha __ _________________________________________________________________ _ _ __ _ _ _ _ _ _ _ _ _ _ _ SIG N AT U R E O F PAR EN T /GU AR D IAN O F J U VEN ILE Firma del Padre/Madre/Tutor del Menor D C -C R 3 ( 1 2 /9 3 ) (OC IS -2 0 0 3 S p a nish) American LegalNet, Inc. www.FormsWorkFlow.com